Treatment of male pattern baldness and postoperative temporal baldness in men.

The use of plastic surgery techniques such as flaps and reductions has resulted in dramatic progress in the treatment of baldness. The operative indications are difficult because of the variety of baldness and the multiple techniques available. Surgeons place themselves at a disadvantage by refusing a specific technique, and this may harm the patient. Surgeons should establish a careful plan before undertaking the treatment of a patient, to make maximum use of the techniques that are available. We prefer flaps and reductions to grafts because of the decrease in the number of operations and time required to obtain a good result. We have described our personal classification, which takes into account the distribution of the hair, the density in each region, and the position of the frontal and temporal hairlines. This enables us to be more precise as to the indications and limitations of surgery. Different modern techniques have been described, concentrating on major reductions or scalp lifts as described by the author, which results in advancement of the crown 6 cm posteriorly and between 2 and 3 cm laterally. Dramatic results can be obtained if one or two vertical flaps are raised during the same operation. Vertical flaps provide a better result than horizontal flaps because they provide a deep android recession and natural forward hair growth. These techniques have the advantage of providing a rapid and aesthetic result after each operation as compared with punch grafts, which require long periods of time before obtaining a reasonable result. Finally, we propose a rapid, easy, two-stage procedure for extensive baldness that combines a one-stage preauricular flap with a scalp lift. The aesthetic result is good and may be completed by another reduction or by punch grafts.